The Research Center at the Jewish Home shares the common goal with other departments and programs of improving the care and quality of life for seniors.

Research enables us to evaluate approaches to care, to assess current therapies and environments, and to design and evaluate new therapies and programs. Through the creation of a center composed of multidisciplinary researchers, we are hoping to minimize the adverse consequences of aging.

The Jewish Home’s Long-Term Care Research Center was formed in 1997 in collaboration with the (Goldman) Institute on Aging. Janice B. Schwartz, M.D., was recruited in September 2001 as director of Research at the Jewish Home. In 2004, the Jewish Home’s research activities became independent under the direction of the Research department.

National Institutes of Health Awards First Grant to Jewish Home

May 15, 2005 was a banner day for the Jewish Home; the Research department, under the leadership of Janice B. Schwartz, M.D., was awarded its first grant from the National Institutes of Health.

“This is an important milestone for the Jewish Home,” says David Friedman, 2004 - 2007 chair of the Home's board of trustees. “It is very exciting to have the opportunity to do this profound research.”

“This grant represents recognition of the Jewish Home as a research institution, a peer reviewed and recognized research facility,” explains Dr. Schwartz. “It will provide a base for the rest of our efforts.”

The grant is for $212,500 per year for five years. In addition to funding direct research costs, it will cover overhead costs of running the program in the Jewish Home. While it will be based at the Home, projects will involve other nursing homes and retirement communities.

The grant has a number of projects within it with a common theme of looking at medications, metabolism rates, and responses to medications in relation to age, gender, race, diet, frailty, alcohol consumption, smoking, co-medication, and medical conditions. One of very few studies in the country focusing on older populations, it will include people over 100 years old.

The first project the grant will fund is continuing studies on the speed at which medication clears the body in elderly men and women. Begun three years ago, the research team found surprising results.

“We hypothesized that increasing age and decreased functional status would decrease clearance rate,” says Schwartz. Instead, they found that clearance rates were the highest (medications left the body at the quickest speed) in patients in nursing homes, some of whom were the oldest and sickest.

According to Dr. Schwartz, not understanding the speed at which medicines are processed through the body can result in both over- and under-medication. “We have wonderful medications today, but the wrong combinations can result in adverse drug reactions and unwanted outcomes. This is most common in older patients with multiple diseases who receive multiple drugs. It is one of the most urgent problems in the care of the elderly.”

Dr. Schwartz and her department plan to develop programs for visiting scholars to join the research and provide educational programs for healthcare professionals and the public.

“The potential impact of these findings on the care of the growing number of very old patients, especially understudied women and minority groups, is great. This is a very exciting opportunity,” she concludes.

Research at the Jewish Home – Year in Review 2007

Residents and employees of the Jewish Home have been involved in research studies over the past year(s) that were completed and published in medical journals in 2007. Publications resulted from two major areas of focus of research supported by the National Institutes of Health and performed in part at the Jewish Home:

1. Bright light treatment or melatonin, or the combination, for sleep, day and night disruption in older nursing home residents with dementia
2. Improving medical therapies for older patients

1. Sleep, day and night disruption patterns in older patients with dementia were investigated by Drs. Glenna Dowling, chair of Physiological Nursing at the University of California, San Francisco, and Jay Luxenberg, Medical Director of the Jewish Home, in residents of the Jewish Home and Laguna Honda. The results appeared in the Western Journal of Nursing Research (1) and in the Journal of the American Geriatric Society (2). Many staff and residents will remember residents sitting in front of the ‘bright light’ boxes for an hour a day, Mondays through Fridays. And certainly the nurses, pharmacy staff, physicians, and residents remember the trial of melatonin! The authors acknowledge the help and contributions of the administration and staff of the Jewish Home and Laguna Honda in the papers.

The conclusions reached were that the bright light treatment alone did not lead to any improvement toward less activity at night and more activity during the day, but when light exposure was combined with melatonin at night, improvement was seen. This intervention could benefit residents and night staff, but also older people at home and their families who are often disturbed, and lose sleep because of nighttime restlessness and activity of patients with dementia.

2. Improving medication therapy for older adults is my major focus at the Jewish Home. I have been investigating age- and gender-related changes in drug metabolism and responses to medications, including the bad effects. I and my research team, and our red collection containers for samples, have been a part of the Jewish Home scenery for a number of years.

I shared the sum of the knowledge I have gained based on this work and the work of others in two major publications in 2007. The first was published in a journal that is read by clinical pharmacologists, physicians, pharmacists and members of the pharmaceutical industry. It highlighted changes with age that should lead to decreased medication doses, and further differences between older women and men that need particular attention to avoid adverse effects (3).

The second publication was a chapter in the major textbook of cardiology that is read by healthcare professionals. It describes the diseases of the cardiovascular system with aging, and how to choose and adjust treatments for cardiovascular diseases in older patients.  Both works acknowledge the Jewish Home in helping to acquire and share this knowledge.

Several other projects are still underway. We look forward to further improvements in the health care of the older patient that will result from this and future research work done at the Jewish Home.

Thank you to all of you – our employees, residents, administration, and our trustees for supporting these activities.

—Janice B. Schwartz, M.D.

Director of Research

Citations

1) Dowling GA, Graf CL, Hubbard EM, Luxenberg JS, Light Treatment for Neuropsychiatric Behaviors in Alzheimer’s Disease. West J Nurs Res. 2007 Jun 27; [E-pub ahead of print]

2) Dowling G, Burr R, Van Someren E, Hubbard E, Luxenberg JS, Mastick J, Cooper B.  Melatonin and Bright Light Treatment for Rest-Activity Disruption in Institutionalized Patients with Alzheimer’s Disease, J. American Geriatric  Society, In Press, 2007.

3) Schwartz JB. The current state of knowledge on age, sex, and their interactions on clinical pharmacology. Clinical  Pharmacology & Therapeutics 2007; 82 (1), 87-96.

4) Schwartz JB and D Zipes.  Cardiovascular Disease in the Elderly, in Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, Eighth Edition. Zipes DP, Libby P, Bonow RO, Braunwald E, Ed. Elsevier/Saunders, Philadelphia, PA. 2008.  Chapter 75: pages 1923-1953.

Ongoing Research Projects at the Jewish Home

Older Persons and Drugs: effects of age, gender and race
(Funded by the National Institute on Aging)
—Janice B. Schwartz, M.D.

The goal of this project is to determine how age, gender, or ethnicity can affect the removal of medications from the body. Among the highlights of Dr. Schwartz’s findings are that women metabolize some, but not all, drugs faster than men; women and men require different doses of medicine; and hormone replacement therapy in women does not affect drug metabolism or responses.

Management of sleep-activity disruption in Alzheimer’s Disease
—Glenna Dowling, Ph. D. and Jay Luxenberg, M.D.

The goal of this project is to test treatments for sleep problems and problem behaviors, such as wandering in people with Alzheimer’s disease. Specifically, researchers are testing whether “bright” light exposure during the day (created by an artificial light box) and/or taking melatonin pills will improve sleep.

Future Programs:

• Complementary and alternative therapies for pain and anxiety
• Programs and interventions for the improvement of nursing homes
• Assessing independence; sleep; daily activities
• Studying therapies for disease states
• Ethics
• End-of-life care
• Visiting scholars and experts
• Lectureships and symposia for the public and for healthcare professionals

Research paper published January 2008. "Melatonin and Bright-Light Treatment for Rest–Activity
Disruption in Institutionalized Patients with Alzheimer’s Disease"

Research Application Procedures

It is our goal to facilitate research projects at the Jewish Home, while meeting the highest ethical standards and compliance with government regulations and Jewish Home policies and procedures.

Applications for research at the Jewish Home are welcomed. Researchers considering projects at the Jewish Home are encouraged to contact Dr. Schwartz before completing the application for research at the Jewish Home.

Janice Schwartz, M.D.

Dr. Janice Schwartz is a leader in the area of cardiovascular aging, drug metabolism, and in the effects of gender on drug metabolism and responses. She graduated from Tulane Medical School, is a board-certified internal medicine specialist, cardiologist, and has added qualifications in geriatric medicine. She has been on the faculty of Stanford Medical School, Baylor College of Medicine, UCSF Schools of Medicine, Nursing and Pharmacy, and Northwestern University Medical School. She is currently clinical professor of Medicine, Divisions of Clinical Pharmacology and Cardiology, University of California, San Francisco.

Dr. Schwartz’s research career has spanned laboratory and clinical research with over 100 publications including scientific articles, reviews, and book chapters. She has been named one of the best doctors in the U.S. for geriatric medicine. She belongs to numerous professional societies, including the American College of Cardiology, American Geriatrics Society, American Heart Association, American Society for Clinical Pharmacology and Therapeutics (past Vice President), and the Society of Geriatric Cardiology (past President). She has served as Associate Editor of the Journal of the American Geriatrics Society, and has been on the National Institutes of Health research review panels for over 12 years.

Jay Luxenberg, M.D.

Dr. Jay Luxenberg is a board-certified internal medicine specialist with a Certificate of Special Competence in geriatric medicine. He is a clinical professor of medicine at the University of California, San Francisco, where he participates in the training of medical students, internal medicine physicians, and physicians training to be geriatricians. He trained at San Francisco’s Mount Zion Hospital, and did a Medical Staff Fellowship at the National Institute on Aging of the National Institutes of Health in Bethesda, Md. His research involved Alzheimer’s disease and changes in the brain associated with healthy aging.

Dr. Luxenberg is the author of many medical publications, and serves as the website editor for the International Psychogeriatric Association (www.ipa-online.org).